Special Formulas: Advocate for Coverage

  • Many children with severe GERD, food allergies or metabolic disorders have serious problems digesting basic formulas and some even have problems with their mother's breast milk. When all else fails many pediatricians will recommend an amino acid based formula for the child.


    Amino acid based formulas can be extremely expensive and many are not covered by insurance. One mom estimated that one month of her child's Neocate formula cost the family nearly $600. This can be an outrageous amount for families dealing with a slow economy along with their child's massive medical bills. Only 13 states now require amino acid based formulas to be covered by insurance.

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    Texas just recently passed such legislation. Though, according to the Neocate website; federal employees, employees receiving insurance through a union and employers who are self-insured are exempt from this law (1). To find out if your state requires insurance coverage for Neocate check here.


    While this legislation is a good start it does not cover other formulas frequently used in some of these conditions like Nutramigen, Pregestimil, and Alimentum which are elemental formulas. Elemental formulas are available in most states through the WIC programs but if you do not meet the income requirements you may not qualify for the program. This can leave a lot of parents in the lurch, deciding how to pay for a formula that may be the only source of their child's nourishment.


    Many of the formula manufacturers have assistance programs so double check their websites to see if you can download coupons or apply for assistance. The bottom line is that until legislation changes this will continue to be a problem. Contact you state reps and let them know that this is a problem you are concerned about! GERD symptoms can be lessened by the use of the correct formula. No child should have to suffer because the formula is too expensive.


Published On: April 06, 2010